Severe obesity is a major health risk that can decrease life expectancy and give rise to a number of other associated ailments, including the onset of cardiovascular disease, hypertension, diabetes and severe arthritis. A number of surgical procedures can be performed to aid in the treatment of obesity. The most common procedure is a gastric restriction procedure in which opposed gastric walls are fastened or stapled together to effectively reduce the volume of a patient's stomach. More specifically, the stomach is divided by a series of staples or fasteners that extend vertically for about 2.5 inches to create a smaller stomach pouch. The outlet of the pouch into the larger stomach limits the amount of food the stomach can hold and reduces the rate of gastric emptying.
Some gastric restriction procedures utilize a series of fasteners that are coupled by a suture used to cinch and pull the fastened tissue together. Suture-coupled fasteners offer the advantage of allowing the surgeon to adjust the tension of the sutures, if necessary, whereas staples must be removed and reapplied. In particular, because the stomach is resilient and tends to stretch to return to its original state, it is often necessary to re-create the gastric restriction over time. Where the stomach is stapled, the original staples must be removed and replaced. Suture-coupled fasteners, on the other hand, allow the surgeon to merely apply additional tension to the suture to keep the stomach walls together.
It may also be necessary to tension the suture during the initial gastric restriction procedure. While suture-coupled fasteners tend to be more advantageous than staples, as the surgeon is attaching the fasteners to the opposed walls of the stomach, slack or loops of excess suture can form. For the gastric restriction procedure to be successful, the suture must be tightly cinched to pull the gastric walls together so that the reduced volume of the patient's stomach can be maintained. If any slack or loose loops of suture are present, the stomach will expand and the restriction procedure will not be effective. Where additional tension is not effective to remove any slack or loops, it may be necessary to knot the excess suture to prevent it from loosening.
Accordingly, a need exists for methods and devices for tensioning a length of suture.